Chapter 8Senses: Sight, Smell, Touch, HearingSlide 3PalpationPalpation: Dorsal Surface of HandPalpation: Ulnar Surface of HandLight vs. Deep PalpationPercussion: Direct vs. IndirectRecognize Percussion SoundsAusculationSettingEquipmentSlide 13A Safer EnvironmentMaintain Safe EnvironmentStandard PrecautionsGeneral Guidelines for the ExaminationSequence for Regional ExamsDevelopmental CompetenceExamining the Ill PersonNursing TipsHIPAAChapter 8Chapter 8Assessment Techniques and Assessment Techniques and the Clinical Settingthe Clinical SettingSenses: Senses: Sight, Smell, Touch, Sight, Smell, Touch, HearingHearingInspectionInspectionPalpationPalpationLight vs deepLight vs deepPercussionPercussionStationary hand & striking handStationary hand & striking handAuscultationAuscultationInspectionInspectionPalpationPalpationPalpation: Dorsal Surface of Palpation: Dorsal Surface of HandHandPalpation: Ulnar Surface Palpation: Ulnar Surface of Handof HandLight vs. Deep PalpationLight vs. Deep PalpationPercussion: Direct vs. Percussion: Direct vs. IndirectIndirectRecognize Percussion Recognize Percussion SoundsSoundsSoundSoundQualitQualityyLocationLocationAbnormAbnormal al locatiolocationnDensitDensityyFlatnessFlatnessFlatFlatMuscle or Muscle or boneboneLungsLungsMost Most densedenseDullnessDullnessThudThudOrgansOrgansLungsLungsResonanResonanceceHollowHollowLungsLungsNoneNoneHyper- Hyper- resonanresonanceceBoomBoomNot normal Not normal in adults; in adults; Normal in Normal in children’s children’s lungslungsTympanTympanyyDrumDrumGastric airGastric airLungsLungsLeastLeastAusculationAusculationSettingSettingRoom: Room: Warm and comfortableWarm and comfortableQuietQuietWell litWell litFurnishings:Furnishings:Examination table (both sides Examination table (both sides accessible)accessible)Head that can be raised to 45°Head that can be raised to 45°Bedside stand or table for equipmentBedside stand or table for equipmentEquipmentEquipmentGet organized!!!Get organized!!!See list on page 119, See list on page 119, JarvisJarvisLearn how to use equipmentLearn how to use equipmentOtoscopeOtoscopeOpthalmoscopeOpthalmoscopeTuning ForkTuning ForkMaintain a clean fieldMaintain a clean field: clean : clean equipment!equipment!Clean vs. used area for handling equipmentClean vs. used area for handling equipmentEquipmentEquipmentA Safer EnvironmentA Safer EnvironmentWash your hands—this is the single Wash your hands—this is the single most important step to decrease most important step to decrease microorganism transmissionmicroorganism transmissionBefore and after physical contact with Before and after physical contact with each patienteach patientAfter inadvertent contact with blood, body After inadvertent contact with blood, body fluids, secretions, and excretionsfluids, secretions, and excretionsAfter contact with any equipment After contact with any equipment contaminated with body fluidscontaminated with body fluidsAfter removing glovesAfter removing glovesSlide 8-14Maintain Safe Maintain Safe EnvironmentEnvironmentNosocomial infectionsNosocomial infectionsHandwashing!!!Handwashing!!!GlovesGlovesUse Standard PrecautionsUse Standard PrecautionsTransmission-based PrecautionsTransmission-based PrecautionsLevels I, II and IIILevels I, II and IIIStandard PrecautionsStandard PrecautionsGeneral Guidelines for the General Guidelines for the ExaminationExaminationIntroduction & Introduction & explanationexplanationMeasurements Measurements firstfirstTouching: Touching: Concentrate Concentrate One step at a timeOne step at a timeLogical sequence Logical sequence Explain procedures Explain procedures throughoutthroughoutEnding:Ending:SummarySummaryExpress gratitudeExpress gratitudeHospital bed Hospital bed lowered lowered Patient is Patient is comfortable and comfortable and safesafeSequence for Regional ExamsAlways begin with inspectionSequence Respiratory and cardiac assessmentsAbdominal assessmentDevelopmental Developmental CompetenceCompetencePosition, preparation, and sequencePosition, preparation, and sequenceInfantsInfantsToddlerToddlerPreschool childPreschool childSchool-age childSchool-age childAdolescentAdolescentAging adultAging adultIll personIll personSlide 8-19Examining the Ill PersonExamining the Ill PersonAlter position for persons in distressAlter position for persons in distressEx: For SOB – have patient sit upEx: For SOB – have patient sit upExamine body areas appropriate for Examine body areas appropriate for problem problem Perform a “mini” assessment Perform a “mini” assessment Finish the complete assessment after any Finish the complete assessment after any distress is resolveddistress is resolvedAvoid over-manipulationAvoid over-manipulationEmergency situation: Emergency situation: Provide emergency care while obtaining Provide emergency care while obtaining necessary Hx (allergies, essential history)necessary Hx (allergies, essential history)Nursing TipsNursing TipsStand on Stand on rightright side of the patient side of the patientUse a head-to-toe approachUse a head-to-toe approachCompare the right- and left-hand Compare the right- and left-hand sides of the body for symmetrysides of the body for symmetryProceed from the least invasive to Proceed from the least invasive to the most invasivethe most invasiveUse a systematic approachUse a systematic approachHIPAAHIPAAHealth Insurance Portability and Health Insurance Portability and Accountability Act of 1996 (HIPAA)Accountability Act of 1996 (HIPAA)First privacy standards to protect patient First privacy standards to protect patient medical records and other health informationmedical records and other health informationKey standardsKey standardsAccess to medical recordsAccess to medical recordsNotice of privacy practicesNotice of privacy practicesLimits on use of personal medical informationLimits on use of personal medical informationProhibition of marketingProhibition of marketingStronger state lawsStronger state lawsConfidential communications with health care Confidential communications with health care